The Obama plan both builds upon and improves our current insurance system, upon which most Americans continue to rely, and leaves Medicare intact for older and disabled Americans. The Obama plan also addresses the large gaps in coverage that leave 45 million Americans uninsured. Specifically, the Obama plan will: (1) establish a new public insurance program available to Americans who neither qualify for Medicaid or SCHIP nor have access to insurance through their employers, as well as to small businesses that want to offer insurance to their employees; (2) make available the National Health Insurance Exchange to help Americans and businesses that want to purchase private health insurance directly; (3) require all employers to contribute towards health coverage for their employees; (4) mandate all children have health care coverage; (5) expand Medicaid and SCHIP to cover more of the least well-off among us; and (6) allow state flexibility for state health reform plans.
Via the PCCC; you can contribute to the
continuing ad campaign at their ActBlue site .
Thus, Obama specifically campaigned for what is now called the “public option” — and it wasn’t just the 8th of 11 bullet points in some forgotten speech in Cornstalk, Iowa, it was the very first specific element of his official health care plan. It was positions like this one that helped convince me, after Edwards’s exit, that the health care issue was at least a rough tossup between Clinton and Obama in the primaries, and helped convince me that Obama was worth working for in the general election campaign. I don’t seem to be the only one, judging by the Progressive Change Campaign Committee’s (PCCC) yeswestillcan.org  site, which placed the ad to the right in the New York Times on Tuesday.
But the “public option” was a disposable afterthought — merely an “additional step we can take” — in Obama’s speech to Congress  on Wednesday evening. Even after noting that a majority of Americans “still” favor the idea, Obama continued:
But its impact shouldn’t be exaggerated — by the left or the right or the media. It is only one part of my plan, and shouldn’t be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage available for those without it. The public option — the public option is only a means to that end — and we should remain open to other ideas that accomplish our ultimate goal. …
Wrong. Having eschewed a single payer model for health care insurance, the public option is utterly necessary for meaningful health care reform. The separate “Health Insurance Exchange” market that Obama and writers like Ezra Klein put much of their faith in will only be as good for Americans as the best insurance provider within that risk-pooling and -adjusting exchange — not just in co-pays and premiums, but in accessibility and service. Without a public option, the profit motive and shareholder pressures all but guarantee that private insurors will see such an exchange as just another regulatory framework to game — either by “innovatively” colluding and signaling industry-wide higher fees and premiums than necessary to eachother, by “innovatively” finding ways to cherrypick the healthiest clients within the exchange without appearing to do so, or both.
In my view, a public health insurance exchange option — a transparent, non-profit “control group”, if you will, for the novel health insurance market that is the Health Insurance Exchange — is absolutely necessary for this system to work in the public interest.
Obama isn’t just risking a bad policy , though, by signaling that he’s willing to throw the public option off the sled. He’d also be making a bad political choice as well.
That’s not just because of caving in to Blue Dogs who rode in on his coattails and Republicans like Grassley who’ve been bargaining in bad faith. (Although that’s a good enough indicator it’s a bad decision.) Much more importantly, abandoning the public option may also turn out to be a fundamental political mistake with voters. Not only do they “still” — Obama’s curious turn of phrase — support it, but as Paul Krugman  points out “…everything I see says that there will be a major backlash against the idea of forcing people to buy insurance from the existing companies. That backlash was part of what got Obama the nomination! Having the public option offers a defense against that backlash.”
Obama went out of his way to describe the public option as no threat to any health insurance profiteers: “it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up”). As Ezra Klein  (who actually joins Obama in being willing to trade public option for votes) put it, “In other words, there’s no reason to worry about the public plan: It won’t really work and very few people will be allowed to use it.”
Thus, the public option is in danger of vanishing altogether, either via a “trigger” that (as Timothy Noah points out in Slate) experience shows will never, ever get pulled , or via the “co-op” notion that will either be too small to work or too attractive not to get gobbled up by regional competitors. The public option should have been something one could voluntarily opt in to. Instead, it’s been pruned back again and again — a compromise with a compromise with a compromise — to be a temporary insuror of last resort.
For my part, I’m watching and I’m waiting. Groups like PCCC are fine and necessary; an “inside-outside” strategy of pressuring and rewarding Democratic incumbents always makes a certain amount of sense for a pressing issue.
The danger is that we’re kidding ourselves, and in so doing take ourselves ever less seriously in these political fights. We’ve been implored to take other issues and approaches off the table to get to a “progressive place,” in Speaker Pelosi’s memorably lackluster phrase  back in 2007. Meaningful, structural health care reform was the prize our eyes were on, the brass ring establishment Democrats have asked us to wait for for years. The outlines of what we’re getting instead looks more like an aluminum pull tab to me.
RALLY ON SUNDAY ON THE CAPITOL GROUNDS: Americans United for Health Care and Insurance Reform  are holding a rally for the public option this Sunday, September 13, from 12-5pm at the “Upper Senate Park,” near the Russell Senate Office Building at Constitution and Delaware (map ).
PUBLIC OPTION: For a collection of various articles about the “public option,” click here .
UPDATE, 9/13: Over at Real News Network, two very good discussions by progressive advocates David Swanson  (afterdowningstreet) and Anthony Wright  (Health Access California) about the politics and strategy of all this. Swanson noted, among other things, the damage done by taking single payer off the table; Wright’s perspective was that he really wants a public option, but doesn’t minimize the value of the rest of the package. (Wright makes a better point than mine about regional coops — they’re potentially a “race to the bottom” to find — or lobby for — the least restrictive state regulations in a given region.) I feel like I was seeing a preview of two leaders for the years ahead. See also Gordon Clark: “After the cheering subsides, what was actually in Obama’s speech? “